If you're pregnant or trying, should you get the vaccine?

Experts around the world disagree about whether to vaccinate against COVID-19 before fertility treatment, during pregnancy and while breastfeeding.  

8 minute read

It's hard enough being an infertility patient. Conflicting advice over vaccination just makes it worse. The problem is that no testing of COVID-19 vaccines has been done with pregnant women. (Eighteen women did accidentally become pregnant during clinical trials, but even those data are not available yet.) 

Below, I sift through the conflicting advice about vaccination before, during and after pregnancy.

Pre-conception: You are thinking of conceiving. Should you be vaccinated first? Fully vaccinated? If fully vaccinated, should you wait a bit before going through insemination or IVF?

Get the vaccine

"Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered."

ASRM

"Women who are trying to become pregnant do not need to avoid pregnancy after receiving an mRNA COVID-19 vaccine."

CDC

"Available data indicate that COVID-19 vaccines do not cause infertility in women or men."

ASRM

Get the vaccine if you want

"The use of any pharmaceutical product in women who are trying to conceive should be subject to a balance between the expected benefit and potential harms. Women who would benefit from the vaccine should be able to receive it without compromising their planned fertility treatment. Women should be made aware that although there is no safety data for COVID-19 vaccinations in pregnancy, there is no known risk from other non-live vaccines in pregnant women. In line with the JCVI guidance, appropriately informed patients who choose to accept COVID-19 vaccination do not need to avoid treatment/pregnancy after vaccination."

BFS

Get the vaccine — maybe — but only if you're at high risk

"For women with co-morbidities putting them at higher risk of COVID-19 and/or pregnancy complications, consideration should be given to encouraging vaccination before attempting conception. The same applies to women in whom the risk of exposure to SARS-CoV-2 infection is high and cannot be avoided." 

ESHRE

Delay pregnancy after getting the vaccine or delay the vaccine until after pregnancy

"There is currently no evidence to guide the time interval between the completion of the COVID-19 vaccine series and conception. In the face of scientific uncertainty, it may be prudent to delay pregnancy by 28 days or more after the administration of the complete two-dose vaccine series of an mRNA COVID-19 vaccine. An mRNA COVID-19 vaccine may be administered anytime after pregnancy."

NACI

"There are different viewpoints with regards to the need to postpone conception after vaccination. It seems prudent to postpone the start of assisted reproduction treatments (sperm collection, ovarian stimulation, embryo transfer) for at least a few days after the completion of vaccination (i.e. after the second dose) to allow time for the immune response to settle. In the absence of information on the effect of the COVID-19 vaccine on oocytes and sperm, embryo implantation and early stages of pregnancy, and to allow time for antibody development, a more cautious approach could be considered (i.e. postpone the start of ART treatment for up to 2 months). 

ESHRE

"Centres should inform patients who have not been vaccinated against COVID-19 but wish to progress with treatment that current Government guidelines may prohibit vaccination until after delivery if a pregnancy is achieved."

BFS

We don’t know

"There is a lack of information on the possible effect of COVID-19 vaccination on assisted reproduction treatment or future pregnancy. The product information for both Comirnaty [Pfizer/BioNTech] and COVID-19 Vaccine Moderna states that animal studies 'do not show any harmful effects in pregnancy'. However, data during pregnancy are reported as 'very limited'... As a result, ESHRE can make no recommendations on whether men and women attempting to conceive through assisted reproduction should receive the vaccine before starting treatment."
ESHRE

Pregnant: You are already pregnant. Should you be vaccinated? What if infection rates where you live are very high? What if you work on the front lines? What if you have health issues that make you more vulnerable?

Get the vaccine

"Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria."

ASRM

Get the vaccine if you want

"Getting vaccinated is a personal choice for people who are pregnant."

CDC

"mRNA vaccines do not contain the live virus that causes COVID-19 and, therefore, cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with a person’s DNA because the mRNA does not enter the nucleus of the cell. Cells break down the mRNA quickly. Based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant."

CDC

[P]regnant patients with COVID-19 are at a greater risk of more severe illness than their non-pregnant peers. Vaccines against diseases such as tetanus, pertussis and influenza have been described as safe during pregnancy. However, the safety of COVID-19 vaccines in human pregnancy has not been evaluated to date... Pregnant women should be informed about the lack of long-term human studies on Covid-19 vaccination, but should not be excluded from vaccination programmes.

ESHRE

Get the vaccine if you are at high risk

"[I]f a pregnant woman meets the definition of being clinically extremely vulnerable, then she should discuss the options of COVID-19 vaccination with her obstetrician and/or doctor. This is because their underlying condition may put them at very high risk of experiencing serious complications of COVID-19. The most likely relevant groups of pregnant women are: solid organ transplant recipients, those with severe respiratory conditions including cystic fibrosis and severe asthma, those who have homozygous sickle cell disease, those receiving immunosuppression therapies sufficient to significantly increase risk of infection, those receiving dialysis or with chronic kidney disease (stage 5), those with significant congenital or acquired heart disease.

"Additionally, pregnant women who are frontline health or social care workers, including carers in a residential home, can also discuss the option of vaccination. This is because the risk of exposure to COVID-19 may be higher, even if they have a lower risk of experiencing complications if they are otherwise well."

RCOG

"Individuals who are pregnant, breastfeeding, or of reproductive age may be at increased risk of exposure to SARS-CoV-2 (e.g., healthcare or essential workers) and/or at increased risk of severe COVID-19 disease (e.g., due to pre-existing medical condition, body mass index of 40 or more) and may wish to be vaccinated despite the lack of evidence of COVID-19 vaccination in pregnancy or during breastfeeding in order to protect themselves. Therefore, the balance of benefits and risks must be made on a case-by-case basis."

NACI

Probably you shouldn't get the vaccine

"The vaccines have not yet been tested in pregnancy, so until more information is available, those who are pregnant should not routinely have this vaccine...Here are the key points you should consider: If you are pregnant you should not be vaccinated unless you are at high risk – you can be vaccinated after your pregnancy is over. If you have had the first dose and then become pregnant you should delay the second dose until after the pregnancy is over (unless you are at high risk)."

Public Health England

"There is no known risk associated with giving non-live vaccines during pregnancy. These vaccines cannot replicate, so they cannot cause infection in either the woman or the unborn child. Although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy."

NCVI

"Although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy."

RANZCOG

The Fetus: What about the baby? 

We don’t know

"[T]he actual risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women."

CDC

"Currently, there are limited data on the safety of COVID-19 vaccine from animal developmental and reproductive toxicity studies. In rats that received the Moderna COVID-19 vaccine prior to or during gestation, no safety concerns regarding female reproduction, fetal/embryonal development, or postnatal development were demonstrated. Developmental and Reproductive Toxicity (DART) animal studies for the Pfizer-BioNTech COVID-19 vaccine are ongoing.

NACI

"Individuals who become pregnant during their vaccine series or shortly thereafter should not be counselled to terminate pregnancy based on having received the mRNA vaccine."

NACI

"If pregnancy is determined after initiation of the vaccination series, completion of the series may be delayed until after pregnancy, unless risk factors for increased exposure or severe COVID-19 are present and informed consent for vaccination is obtained..."

NACI

"The early COVID-19 vaccines do not contain organisms that can multiply in the body, so they cannot infect an unborn baby in the womb."

Public Health England

Breastfeeding: You are breastfeeding. Is it safe to be vaccinated?

Probably

"There are no data on the safety of COVID-19 vaccines in lactating women or on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion. mRNA vaccines are not thought to be a risk to the breastfeeding infant."

CDC

"It is unknown whether the vaccines are excreted in human milk, but there are no data on outcomes in breastfeeding individuals or their breastfed infants. There have been no theoretical concerns about these vaccines in breastfeeding individuals or their breastfed infants."

NACI

The JCVI also now advises that there is no known risk in giving these vaccines to breastfeeding women. Breastfeeding women should therefore be offered vaccination if they are otherwise eligible, for example if they are a frontline health or social care worker, including a carer in a residential home. Women should be advised that there is lack of safety data for these specific vaccinations in breastfeeding.

RCOG

"There are no data on the safety of COVID-19 vaccines in breastfeeding or on the breastfed infant. Despite this, COVID-19 vaccines are not thought to be a risk to the breastfeeding infant, and the benefits of breast-feeding are well known. Because of this, the JCVI has recommended that the vaccine can be received whilst breastfeeding... If you are breastfeeding, you may decide to wait until you have finished breastfeeding and then have the vaccination."

Public Health England

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American Society for Reproductive Medicine (ASRM): 

Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic UPDATE No. 11 –COVID-19 Vaccination and UPDATE No. 12 - Testing and Vaccine Truths

European Society of Human Reproduction and Embryology (ESHRE): 

Statement on COVID-19 vaccination and medically assisted reproduction

British Fertility Society (BFS):

Addendum: Covid 19 Vaccination

Royal College of Obstetricians and Gynaecologists (RCOG): 

Updated advice on COVID-19 vaccination in pregnancy and women who are breastfeeding

National Advisory Committee on Immunization (NACI):

Recommendations on the use of COVID-19 vaccines

Centers for Disease Control and Prevention (CDC): 

Vaccination Considerations for People Who Are Pregnant or Breastfeeding

Public Health England:

COVID-19 vaccination: a guide for women of childbearing age, pregnant or breastfeeding

Joint Committee on Vaccination and Immunisation (JCVI):

Advice on priority groups for COVID-19 vaccination

Royal Australian and New Zealand College of Obstetricians and Gynaecologists:

COVID-19 Vaccination in Pregnant and Breastfeeding Women

Also check out:
The Progress Educational Trust is hosting an open meeting on this question next week. 

The COVID Vaccine: A Short in the Arm for Fertility Treatment

Harvard Health Publishing: 

"Wondering about COVID-19 vaccines if you're pregnant or breastfeeding?"

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